A: There are several types of bariatric operations, but none work without a substantial degree of knowledge and effort on your part and the help and guidance of an expert team. Help and guidance after surgery is key to both losing weight and keeping the weight off in a healthy way.
The most important concept for patients to remember is that these operations only help you comply with your diet. They don't replace the need to actively work at managing the amount and type of food you eat. Bariatric surgery may help with reducing the perception of hunger, an issue few diets and exercise programs address and why they often fail.
Diets often fail because it's impossible to function or perform properly in a perceived caloric deficit. A complex symphony between the brain, fat cells, muscle fibers, and the gastrointestinal tract regulates hunger and energy expenditure. This is where bariatric surgery helps beyond medical therapy, diet, and exercise. Success depends on the individual, and each individual has a different goal. Bariatric surgery is only a tool for weight loss. Weight loss is important, but the results from weight loss are really important.
The whole purpose is to live longer and to live better.
A: Those with a BMI of 35 or greater with a medical problem directly related to obesity are candidates for bariatric surgery. To put things in perspective, a normal BMI ranges from 18-25. In 2011 the Food and Drug Administration approved Lap-Band placement for patients with a BMI of 30 or greater, in special circumstances. Whether someone is an appropriate candidate for surgery depends on the patient's overall medical condition and commitment.
A: A typical patient will meet one of our bariatric surgeons and the support staff at the free Bariatric Information Seminar, which is usually held weekly. Depending on medical clearances and insurance/financial clearances, the whole process may take three to six months, depending on individual insurance requirements.
At UT Southwestern Medical Center, we stress that the best patient is the educated and committed patient who prepares diligently in anticipation of surgery for the best long-term results. Weight loss does not begin after bariatric surgery; weight loss begins once you are committed and trust the process that's been proven to work.
A: Yes. The obesity epidemic has become a great burden on our health care system. More than $100 billion is spent annually on obesity-related medical problems in the U.S. alone.
Most insurance carriers, including Medicare, have recognized this concern and typically cover bariatric operations if you are a good candidate for surgery.
The total cost of bariatric surgery depends on several factors such as hospital fees, professional fees, and anesthesia fees. The cost can range from $10,000 to $20,000, depending on the type of operation. UT Southwestern offers information on alternative financial options for surgery.
With the rising cost of health care to the individual patient due to obesity-related illness, resulting in sick days, decreased productivity, hospitalizations, and rising medication costs, the average return on investment is about two years. This means that in one's lifetime, surgery will pay for itself in about two years due to savings in potential cost.
A: For most people, the gastric bypass is most effective for weight loss. By creating a small gastric pouch and bypassing the first portion of the small intestine, portion sizes must be smaller and fats tend to get absorbed later than they normally would.
Ingesting highly concentrated simple sugars or fats may cause "dumping syndrome." Symptoms include panic attack-like sensations with severe headache, dizziness, nausea, abdominal cramping, and diarrhea. "Dumping" is a very unpleasant sensation but can be avoided by avoiding foods with high simple sugar or high fat content, which are the foods that cause weight gain in the first place.
Patient must avoiding "dumping" for gastric bypass and sleeve gastrectomy to be effective. Most patients reach their weight loss goal in one year or one-and-a-half years. Overall effectiveness and success depend on the habits and tendencies of the individual patient, and the best operation for each person may be different.
A: Lap-Band is highly effective for the right patient. The procedure forces patients to eat smaller portions and chew each bite more than 20 times before swallowing. It may take two to five years for patients to lose their desired weight. Success for this operation is highly dependent on patients' compliance with their diets and patients who eat too much or too fast will vomit. This repetitive behavior will cause damaging effects to the stomach and esophagus.
At UT Southwestern, patients who undergo band placement are carefully followed throughout the first year for band adjustments and receive diligent nutrition counseling for optimal weight management. After the first two years, annual checkups are typically recommended.
A: More and more insurance carriers are providing coverage for the sleeve gastrectomy. The medical community is embracing this operation as an alternative to the band and bypass procedures because the results and the risks are in the middle. There is excellent midterm scientific data from the past five-plus years to prove the effectiveness of the sleeve, with results almost comparable to the bypass yet with a lower risk profile.
In the past, the sleeve gastrectomy was often the first part of a staged bypass-type operation in high-risk patients. The idea behind it was to perform a sleeve in high-risk patients so that they would lose weight. The patient would then return for a second operation once they lost the weight. Many patients did well after just a sleeve, often deciding against an additional operation because of the satisfactory results. This is why the scientific data is currently behind what's already been published about the band and bypass. What we’re discovering is that the results are good and the sleeve gastrectomy is another excellent option for the right patient.
A: The type of surgery that's best for you will be determined by a team looking out for your best interest – not the surgeon's best interest or the hospital's best interest. Our multidisciplinary team consists of bariatric surgeons, clinical psychologists, registered dietitians, and physician assistants with expertise in bariatrics.
Unlike most bariatric practices, the team, not just one surgeon, collectively recommends the safest and best operation for each patient. Our team considers each patient individually, taking into account the patient's physical condition and ability to exercise, dietary habits, lifestyle, emotional concerns, etc. The team guides each patient into making an informed decision and provides individualized long-term care after an operation is complete.
A: Absolutely. Follow-up care remains key to successful and safe weight loss. Most problems are easy to take care of if identified early. We encourage interval follow-up. Unlike other types of surgery, bariatric surgery is a lifelong commitment. A patient will only achieve long-term successful results with diligence and proper guidance.
Each type of operation requires a series of follow-up visits, which are spread over three months in the first year for sleeves and bypass patients and over several weeks for band patients. Vitamin levels are checked at regular intervals. After the first year, annual checkup visits are recommended for all patients.
A: Not exactly. In most circumstances, Lap-Bands are easily taken out and the anatomy is usually left undisturbed. However, anytime you have surgery, scar tissue is left behind and nothing is exactly the same as it was before. Sleeve gastrectomies can be converted to a bypass. Band patients can have their bands removed and be converted to a sleeve or bypass.
In general, it’s always safest and most effective to pick and choose the right operation the first time rather than viewing your surgical options as second- or third-choice alternatives. At UT Southwestern, we stress diligent counseling to thoroughly review risks and benefits to help patients decide the best operation so that their first bariatric operation is their last bariatric operation.
A: The biliopancreatic diversion (BPD) is an extreme form of the Roux-en-Y gastric bypass that was first performed in 1976 by Dr. Scopinaro, a general surgeon. The duodenal switch (DS) is a variation of the biliopancreatic diversion, which was first performed in 1990 by Dr. Marceau.
Although the BPD and DS are highly effective, both have fallen out of favor within the bariatric community because of problems with uncontrollable diarrhea and malnutrition. It is an option that insurance carriers typically will not cover. Most academic research centers will offer BPD or DS as an option in the context of an Institutional Review Board (IRB) for research. We recommend BPD or DS only with a surgeon with reported success with this operation under an IRB-approved research study after an informed consent is obtained with intense counseling.
A: Metabolism is a lot more complex than we once thought. Bariatric surgery is not simply cutting out the stomach and making it smaller or just rerouting it. In fact, the medical and surgical community refers to these operations as metabolic surgery because surgery effectively treats many of the medical problems related to weight gain.
Scientists have isolated dozens of hormones involved in metabolism. In reality, there may be hundreds of hormones involved in regulating hunger and metabolism. Everything, including medications and surgery, involves risk. No magic pill for weight loss without major serious side effects currently exists.
Medications and endoscopic procedures are more likely to be useful as a bridge to lose weight for patients with extremely high BMIs or patients who are no longer good candidates for surgery because of advanced age and medical problems. Some endoscopic procedures are currently being researched.
An earlier permanent solution is the safest and most effective way to minimize the damaging wear and tear on our bodies. Nothing has been studied and scrutinized as much as bariatric surgery. Bariatric surgery remains the best tool for weight loss and for eliminating problems associated with weight gain because of its long-proven safety and effectiveness.